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Customize a 6 page form for medical website

Customizing an online and coding it to where it can be fillable. Here is what the form contains: Name, address, insurance info, check boxes (like the sample forms I have added). (The sample forms are similar to the originals). The form is 6 pages.

A signature is needed at the end of the form. The doctor will purchase a tablet (Android or Mac) so his patients can fill out this medical form in his office, and also sign their signature using a touch screen tablet stylus pen. There should be a send button where the files will go to a secure location where medical staff can access them.

Developer should be familiar with security protocols and have a good command of English.

Sample work is a plus. You should tell us something about yourself, your experience and why you would be a good fit for the job. We just want to get to know you a little better.

Should also have an eye for design. We need the form to look exactly like the ones we will be supply.

Once I find the right developer for this project, will present the info to the client and if he agrees and pays, we will move forward.

We do not have a budget in mind so just tell us what something like this would cost. Remember you are not designing a new website, you will be developing a customized form on an existing website.

Compétences : Conception graphique , HTML, PHP, Sécurité Web, Design de site internet

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Concernant l'employeur :
( 6 commentaires ) round rock, United States

N° du projet : #8473565

49 freelance ont fait une offre moyenne de 555 $ pour ce travail

infoway

Hi, We've built similar form for a Health Care Agency website. So, can provide you the best possible solution. http://thexeta.com/dev/vancouverhhc/job-application/ http://thexeta.com/dev/vancouverhhc/request-ca Plus

567 $ USD en 12 jours
(380 Commentaires)
9.0
meet2amitvw

Let's discuss over freelancer Personal Message Box for the proper estimation of cost and time. I am myself developer so you will directly work with me. No mediators. No managers. No subcontractors. see my recent Plus

721 $ USD en 10 jours
(124 Commentaires)
8.7
madhavdutta

Hello Dear, Hope you are doing well !! I have gone through your project description and as per my understanding you are looking for customization of 6 pages form for medical website. For fulfilling your requirem Plus

1855 $ USD en 30 jours
(212 Commentaires)
8.8
A2Design

Hello, We’re preferred freelancers thus very reliable and we'd like to help you with these forms. See our skills at: http://www.a2design.biz/portfolio_ What's your current website built on? Can you send a Plus

500 $ USD en 10 jours
(84 Commentaires)
8.4
seekdeveloper

Hi, I have read your post and understood your requirement. I have great experience in handling /PHP/MySQL/HTML5/jQuery/Wordpress/Magento/Joomla/Drupal/AngularJS/node.js/CSS3/Java/Python/Django/Javascript/iOS/Andr Plus

1030 $ USD en 10 jours
(101 Commentaires)
8.3
mindblowcreative

Hello, We do like your project and we are interested. The project is in the core of our expertise: Web Design, Development and User-experience and we are all confident that we can do an excellent job on this Webs Plus

773 $ USD en 15 jours
(66 Commentaires)
8.0
narmadatech

Thanks for sharing document " I have few quick questions to ask , Kindly Note - This is not a standard reply, I truly like your post, however I would first like to have a discussion for my questions. Once we have Plus

1578 $ USD en 10 jours
(147 Commentaires)
7.4
mituld

Hi I work towards providing reliable, relevant and robust IT solutions at most competitive prices to my customers. I ensure 100% customer satisfaction so lets start Thanks

463 $ USD en 15 jours
(244 Commentaires)
7.7
Properbouncetech

Thank you for checking this bid proposal. Myself is Aloysius. Yes, i do confirm that what we need to do is to design the highlighted 6 medical forms mentioned. I truly believe that my team are capable eno Plus

315 $ USD en 5 jours
(138 Commentaires)
7.7
Infenixwebs

Hi, I have experience in web projects, if you check my reviews you will see that I have gotten excellent results from previous employers. If you have any questions or concerns please do not hesitate to contact me, than Plus

600 $ USD en 14 jours
(260 Commentaires)
7.7
darkwind

Hello, I have a few questions: 1. You mentioned that the form will be 6 pages and the form to look like the form you attached. Is it 6 pages with each form like the one you attached? Or is it the form you attache Plus

555 $ USD en 14 jours
(228 Commentaires)
7.0
ayudeveloperssl

Hi there this is very easy job for me i need to discuss this project in details so please send me message when ever you got time. you can check our work http://portfolio.ayudevelopers.com/ You can check my f Plus

421 $ USD en 7 jours
(368 Commentaires)
7.1
naveedmanzoor21

Dear Customer, Greetings from Dreamrun Technologies Private Limited Hi My name is micky. I understood your requirement of customizing an online medical -patient registration form and Health record of the patient's, Plus

526 $ USD en 7 jours
(37 Commentaires)
7.1
techwelfare

Dear Sir we are capable of performing the required task perfectly with accuracy, please let us know if you want to clarify in details.. if you want us to share our skill and previous work please initiate the chat b Plus

522 $ USD en 17 jours
(119 Commentaires)
6.8
conceptsview

HI, Please check some completed projects, then you can easily understand my work ability & quality. http://www.royalaroma.com/ http://infomediasolutions.com/ https://greenlightingbiz.com/ http://www.greenclea Plus

478 $ USD en 7 jours
(53 Commentaires)
6.5
VnBestSolutions

Dear Sir. We claim to get it done perfectly for you EXACTLY in the way you want it - Kindly give we a chance and we will prove myself - Ready to prove our words, let's get it done right away and I mean RIGHT AWAY !! Plus

736 $ USD en 10 jours
(115 Commentaires)
6.6
prashushinde9

I want to discuss this project with you further, let me know the best suitable time for you to schedule the meeting, Feel free to message me at any time, i used to be online 14 hrs in a day on this website so probably Plus

793 $ USD en 15 jours
(52 Commentaires)
6.7
JoeLtheMaster

Hi there, My name is Joel. I've read your brief and can see that you’d like to build a website. We are properly established company. My team has 6 years experience designing and developing websites for personal and Plus

300 $ USD en 6 jours
(267 Commentaires)
7.0
developerhunk

Hello sir,, I have read the project description & requirements carefully. I have checked the both attachment , I am confident that i can do it on time.. I would be very obliged if u will give me a chance to talk to you Plus

610 $ USD en 21 jours
(44 Commentaires)
6.7
kishanlalyadav

HI SIR AWARD ME RIGHT NOW I M 100% CONFIDENT FOR THIS PROJECT!!! I am ready to start this immediately. I am extremely eager and ready to go. I am all of the following; attentive, detailed, creative, dedicated, efficie Plus

555 $ USD en 6 jours
(333 Commentaires)
6.7